How to diagnose dissociative fugue

Formerly called psychogenic fugue, dissociative fugue, is a psychological state in which a person loses awareness of their identity or other important autobiographical information. This subtype of dissociative amnesia often includes some form of unexpected travel. People who experience a dissociative fugue may suddenly find themselves in a place, such as on the beach or at work, with no memory of traveling there. Similarly, they may find themselves somewhere in their home, such as a closet or in the corner of a room, with no memory of getting there. The DSM-5 refers to dissociative fugue as a state of “bewildered wandering.”

In addition to confusion about identity, people experiencing a dissociative fugue state may also develop a new identity. Dissociative fugue is a rare condition, with prevalence estimates as low as 0.2 percent in the general population. Dissociative fugue states are more common in adults than in children; symptoms usually appear in a person’s 20s and 30s, but sometimes it can show up in kids as young as 8 years of age.

Contents

  • Symptoms
  • Causes
  • Treatment

Symptoms

Dissociative fugue is more commonly found in people who experience dissociative identity disorder. Dissociation is generally thought of as a defense against trauma that helps people disconnect from extreme psychological distress. A dissociative fugue state is a condition in which a person may be mentally and physically escaping an environment that is threatening or otherwise intolerable.

The travel that may occur in a dissociative fugue state can last for as little as a few hours or a few weeks, or sometimes even months. In some cases, dissociative fugue can be very difficult to distinguish from sleepwalking. When the fugue state is over, people usually cannot remember what happened during the period of fugue. The fugue state can end suddenly or more gradually. Symptoms include:

  • Persisting confusion about identity
  • Persisting confusion about the past
  • Refuses to be challenged about their beliefs, especially who they are

What is the difference between dissociative fugue and dissociative amnesia?

Dissociative fugue is a subtype of dissociative amnesia. In these two types of dissociation, a person can lose awareness of identity or personal history or other autobiographical information. The person with dissociative fugue may find himself wandering physically to other locations, oftentimes in far-off destinations. Fugue can last longer than dissociative amnesia, sometimes up to months.

What is the difference between dissociative fugue and dissociative identity disorder?

Dissociative identity disorder is formerly known as multiple personality disorder, where identity is fragmented into two or more personality states. It has been described as a state of possession. Memory loss can also be severe. This disorder often presents itself in people who have been abused.

Is dissociative fugue similar to an out-of-body experience?

These are not the same, though the out-of-body experience is a dissociative state. In the out-of-body experience, the person is awake but views his body from outside his body. Researchers believe that this state involves the brain’s right temporoparietal cortex.

Causes

The onset of a dissociative fugue state is usually sudden and follows a traumatic or highly stressful event. Dissociative fugues are associated with difficult events, such as natural disasters and wars, as well as severe marital or financial distress, alcohol abuse, depression, and a history of child abuse. There may also be a genetic link because individuals with dissociative disorders sometimes have family members with the same condition.

Treatment

There is no specific treatment for dissociative fugue, in part due to the rarity of the condition. The process of recovery may begin when people experiencing dissociative fugue become spontaneously aware of the situation, or when they are unable to appropriately respond to questions about their background during an episode of dissociative fugue.

Effective treatment practices include removing a person from the threats or stressful situations that may have contributed to the development of a dissociative fugue state. An empathic, supportive approach to psychotherapy will help people who have experienced dissociative fugue, feel safe and open to treatment. The treatment process may include developing healthy coping skills that help people manage stress and psychological pain more effectively. Other forms of therapy, such as cognitive-behavioral therapy and dialectical behavioral therapy may also be employed.

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, MD, Stanford University School of Medicine

Dissociative fugue is a rare form of dissociative amnesia.

A dissociative fugue may last from hours to months, occasionally longer. If the fugue is brief, people may appear simply to have missed some work or come home late. If the fugue lasts several days or longer, people may travel far from home, form a new identity, and begin a new job, unaware of any change in their life.

Many fugues appear to represent disguised wish fulfillment or the only permissible way to escape from severe distress or embarrassment. For example, a financially distressed executive leaves a hectic life and lives as a farm hand in the country.

Thus, dissociative fugue is often mistaken for malingering (faking physical or psychologic symptoms to obtain a benefit) because both conditions can give people an excuse to avoid their responsibilities (as in an intolerable marriage), to avoid accountability for their actions, or to reduce their exposure to a known hazard, such as a battle. However, dissociative fugue, unlike malingering, occurs spontaneously and is not faked. Doctors can usually distinguish the two because malingerers typically exaggerate and dramatize their symptoms and because they have obvious financial, legal, or personal reasons (such as avoiding work) for faking memory loss.

Symptoms of Dissociative Fugue

During the fugue, people may appear and act normal or appear only mildly confused and attract no attention. However, when the fugue ends, people suddenly find themselves in a new situation with no memory of how they came to be there or what they have been doing. At this point, many people feel ashamed or upset that they cannot remember what happened. Some people are frightened. If they are confused, they may come to the attention of medical or legal authorities.

After the fugue ends, many people remember their past identity and life up to when the fugue began. However, for others, remembering takes longer and occurs more gradually. Some people never remember parts of their past. A very few people remember nothing or almost nothing about their past for the rest of their life.

Diagnosis of Dissociative Fugue

A doctor’s evaluation

Doctors may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances.

Usually, dissociative fugue is diagnosed after the fact, when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternate life.

Treatment of Dissociative Fugue

Sometimes hypnosis or drug-facilitated interviews

If people have had dissociative fugues, psychotherapy, sometimes combined with hypnosis or drug-facilitated interviews (interviews conducted after a sedative is given intravenously), may be used to try to help people remember the events of the fugue period. However, these efforts are often unsuccessful.

Regardless, a therapist can help people explore how they handle the types of situations, conflicts, and emotions that triggered the fugue and help them find better ways to respond in the future. This approach can help prevent fugues from recurring.

In this Article

  • What Are the Symptoms of Dissociative Fugue?
  • What Causes Dissociative Fugue?
  • How Common Is Dissociative Fugue?
  • How Is Dissociative Fugue Diagnosed?
  • How Is Dissociative Fugue Treated?
  • What Is the Outlook for People With Dissociative Fugue?
  • Can Dissociative Fugue Be Prevented?

Dissociative fugue, formerly called psychogenic fugue, is one of a group of conditions called dissociative disorders. The word fugue comes from the Latin word for “flight.” People with dissociative fugue temporarily lose their sense of personal identity and impulsively wander or travel away from their homes or places of work. They often become confused about who they are and might even create new identities. Outwardly, people with this disorder show no signs of illness, such as a strange appearance or odd behavior.

Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, conscious awareness, identity, and/or perception. When one or more of these functions is disrupted, symptoms can result. These symptoms can interfere with a person’s general functioning, including social and work activities, and relationships.

What Are the Symptoms of Dissociative Fugue?

A fugue in progress often is difficult for others to recognize because the person’s outward behavior appears normal. Symptoms of dissociative fugue might include the following:

  • Sudden and unplanned travel away from home
  • Inability to recall past events or important information from the person’s life
  • Confusion or loss of memory about their identity, possibly assuming a new identity to make up for the loss
  • Extreme distress and problems with daily functioning (due to the fugue episodes)

What Causes Dissociative Fugue?

Dissociative fugue has been linked to severe stress, which might be the result of traumatic events — such as war, abuse, accidents, disasters, or extreme violence — that the person has experienced or witnessed. The use or abuse of alcohol and certain drugs also can cause fugue-like states, such as alcohol-induced “blackouts.”

How Common Is Dissociative Fugue?

Dissociative fugue is relatively rare. The frequency of dissociative fugue tends to increase during stressful or traumatic periods, such as during wartime or after a natural disaster.

How Is Dissociative Fugue Diagnosed?

If symptoms of dissociative fugue are present, the doctor will often begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose dissociative disorders, the doctor might sometimes recommend various diagnostic tests, such as neuroimaging studies, electroencephalograms (EEGs), and blood tests, to rule out physical illness or medication side effects if these are suspected as causing the symptoms. Certain conditions — including brain diseases (such as epilepsy), head injuries, drug and alcohol intoxication, and sleep deprivation — can lead to symptoms similar to those of dissociative disorders, including amnesia (loss of memory).

If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interviews and assessment tools to evaluate a person for a dissociative disorder.

How Is Dissociative Fugue Treated?

The goal of dissociative fugue treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of their symptoms, but most likely will include some combination of the following treatment methods:

  • Psychotherapy: Psychotherapy, a type of counseling, is the main treatment for dissociative disorders. This treatment uses techniques designed to encourage communication of conflicts and increase insight into problems.В Cognitive therapy is a specific type of psychotherapy that focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
  • Medication: There is no established medication to treat the dissociative disorders themselves. However, if a person with a dissociative disorder also suffers from depression or anxiety, they might benefit from treatment with a medication such as antidepressant, anti-anxiety, or antipsychotic drugs.
  • Family therapy: This helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
  • Creative therapies (art therapy, music therapy): These therapies allow the patient to explore and express their thoughts and feelings in a safe and creative way.
  • Clinical hypnosis: This is a treatment method that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings, and memories they might have hidden from their conscious minds. The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories.

What Is the Outlook for People With Dissociative Fugue?

Most dissociative fugues are brief, lasting from less than a day to several months. Often, the disorder goes away on its own. The outlook, therefore, is quite good. However, without treatment to work out the underlying problem, additional fugue episodes can occur.

Can Dissociative Fugue Be Prevented?

Although it might not be possible to prevent dissociative fugue, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Further, quick intervention following a traumatic event or emotionally distressing experience might help reduce the risk of developing dissociative disorders.

This article was co-authored by Noel Hunter, Psy.D. Dr. Noel Hunter is a Clinical Psychologist based in New York City. She is the director and founder of MindClear Integrative Psychotherapy. She specializes in using a trauma-informed, humanistic approach for treating and advocating for people diagnosed with mental disorders. Dr. Hunter holds a BA in Psychology from the University of South Florida, an MA in Psychology from New York University, and a doctorate in Psychology (Psy.D) from Long Island University. She has been featured in National Geographic, BBC News, CNN, TalkSpace, and Parents magazine. She is also the author of the book Trauma and Madness in Mental Health Services.

There are 17 references cited in this article, which can be found at the bottom of the page.

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A dissociative fugue, which is a form of dissociative amnesia, occurs when someone temporarily loses his sense of identity, usually due to extreme stress. A person may become confused of who he is or create a new identity entirely. This may last for a few hours, a few months — sometimes even for years. [1] X Trustworthy Source National Alliance on Mental Illness Grassroots mental health-focused organization providing resources, support, and education for those affected by mental illness Go to source During dissociative fugue, the person will travel or wander from his home and normal life — sometimes traveling a great distance. A dissociative fugue cannot be predicted and while the person may have lapses in memory, perception, and identity, the individual doesn’t appear as mentally ill or as having disruptive functioning.[ [2] X Trustworthy Source National Alliance on Mental Illness Grassroots mental health-focused organization providing resources, support, and education for those affected by mental illness Go to source Despite the elusiveness of dissociative fugue, there are treatment options available.

, MD, Stanford University School of Medicine

Dissociative fugue is a rare form of dissociative amnesia.

A dissociative fugue may last from hours to months, occasionally longer. If the fugue is brief, people may appear simply to have missed some work or come home late. If the fugue lasts several days or longer, people may travel far from home, form a new identity, and begin a new job, unaware of any change in their life.

Many fugues appear to represent disguised wish fulfillment or the only permissible way to escape from severe distress or embarrassment. For example, a financially distressed executive leaves a hectic life and lives as a farm hand in the country.

Thus, dissociative fugue is often mistaken for malingering (faking physical or psychologic symptoms to obtain a benefit) because both conditions can give people an excuse to avoid their responsibilities (as in an intolerable marriage), to avoid accountability for their actions, or to reduce their exposure to a known hazard, such as a battle. However, dissociative fugue, unlike malingering, occurs spontaneously and is not faked. Doctors can usually distinguish the two because malingerers typically exaggerate and dramatize their symptoms and because they have obvious financial, legal, or personal reasons (such as avoiding work) for faking memory loss.

Symptoms of Dissociative Fugue

During the fugue, people may appear and act normal or appear only mildly confused and attract no attention. However, when the fugue ends, people suddenly find themselves in a new situation with no memory of how they came to be there or what they have been doing. At this point, many people feel ashamed or upset that they cannot remember what happened. Some people are frightened. If they are confused, they may come to the attention of medical or legal authorities.

After the fugue ends, many people remember their past identity and life up to when the fugue began. However, for others, remembering takes longer and occurs more gradually. Some people never remember parts of their past. A very few people remember nothing or almost nothing about their past for the rest of their life.

Diagnosis of Dissociative Fugue

A doctor’s evaluation

Doctors may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances.

Usually, dissociative fugue is diagnosed after the fact, when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternate life.

Treatment of Dissociative Fugue

Sometimes hypnosis or drug-facilitated interviews

If people have had dissociative fugues, psychotherapy, sometimes combined with hypnosis or drug-facilitated interviews (interviews conducted after a sedative is given intravenously), may be used to try to help people remember the events of the fugue period. However, these efforts are often unsuccessful.

Regardless, a therapist can help people explore how they handle the types of situations, conflicts, and emotions that triggered the fugue and help them find better ways to respond in the future. This approach can help prevent fugues from recurring.

Dissociative disorders are highly problematic, and they are often terrifying for individuals who suffer from them as well as those who love them. Dissociative fugue temporarily causes individuals to lose all concept of who they are. They can’t recall their own identity. They don’t know what they are doing, where they are, and what is going on in their lives. This confusion might not last forever, and it is also very rare for someone to suffer from this. It typically occurs in individuals who experience trauma, severe stress, or exceptional violence. It’s also more common following war, abuse, and even a disaster. The problem with this disorder is no one knows when it might occur. It happens suddenly and without warning. However, there are some recognizable symptoms. Reveal the details now.

Memory Loss Or Confusion About Personal Identity

How to diagnose dissociative fugue

Memory loss or confusion about personal identity is the number one symptom of dissociative fugue. Someone behaving in a confused manner by stating they are not sure who they are or what they are doing, could be a symptom of dissociative fugue. This person might be very confused and seem unsure about what is going on. They may not know their name or where they are from. They will act confused about what they are doing, and most of the individuals who suffer from dissociative fugue will assume a new identity to provide themselves with some comfort during this confusing time. It is very rare for a disorder like this to occur, so it’s helpful to know what might cause it to identify the issue quickly and efficiently, with the assistance of a doctor.

Learn more about the symptoms of dissociative fugue now.

Inability To Recall Events

How to diagnose dissociative fugue

When someone suffers from dissociative fugue, they are often unable to recall events. This could be minor events such as what they ate for breakfast or even driving their car to work that morning. They are also unable to recall large events such as weddings and even the birth of their baby. It’s shocking when someone you love suddenly has no idea who you are or how you met, and it can cause stress and additional confusion. Asking someone to recall some larger events in their life can cause them to feel anxious when their memories aren’t there. They might be aware they don’t know who they are, but they don’t understand what is happening other than that they are losing some of their memory. They might find it difficult to trust those around them, and it can cause extreme distress.

Continue reading to reveal more dissociative fugue symptoms now.

Extreme Distress

How to diagnose dissociative fugue

Extreme distress, when it’s associated with dissociative fugue, doesn’t always subside as the days go on. Some individuals find that not only do they have no idea who they are or what they are doing in life, they also find it difficult to function on a daily basis. Perhaps they aren’t sure how to get ready in the morning or what to do when they get home. This kind of confusion and anxiety can cause distress so extreme it’s painful to watch. When someone cannot figure out where they live, how to get to work, or even recognize their loved ones, it’s more than frustrating. Imagine spending your life unable to recognize everyone around you when they know who you are. Imagine being the only person in your life who has no idea what happened in their life, but everyone else has memories involving them. This is what causes this level of distress.

Get details on more signs of dissociative fugue now.

Sudden Travel Away From Home

How to diagnose dissociative fugue

When an individual is dealing with an episode of dissociative fugue, they might suddenly travel away from home. They might find they are too upset to live with their families not knowing anything about them, and they might travel away from home to get away from the pain they feel they are inflicting on their loved ones. Some individuals just disappear without a trace because they aren’t with their loved ones or anyone familiar to them when they experience dissociative fugue. This means they’re alone, don’t know what to do, where to go, or who to talk to, and many individuals are too scared to ask for help. They’re afraid of what might happen if they approach a hospital or even the police about this, and they might choose to keep their problems to themselves.

Discover more symptoms of dissociative fugue now.

Issues With Functioning

How to diagnose dissociative fugue

It’s not easy to function when dealing with dissociative fugue. Even the simplest day to day tasks such as showering and getting ready in the morning are difficult. This level of stress is beyond comprehension, and it causes individuals to develop issues with functioning each day. Individuals often feel confused, resulting in pauses in what they are trying to do every so often or even knee-jerk reactions that can injure themselves or others around them. Issues with functioning can also include impaired work activities and issues with relationships of all kinds. Individuals dealing with dissociative fugue and who have issues functioning often look as if they are in a fog the majority of the time.

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Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder.

Up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes. Women are more likely than men to be diagnosed with a dissociative disorder.

The symptoms of a dissociative disorder usually first develop as a response to a traumatic event, such as abuse or military combat, to keep those memories under control. Stressful situations can worsen symptoms and cause problems with functioning in everyday activities. However, the symptoms a person experiences will depend on the type of dissociative disorder that a person has.

Treatment for dissociative disorders often involves psychotherapy and medication. Though finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.

Symptoms

Symptoms and signs of dissociative disorders include:

  • Significant memory loss of specific times, people and events
  • Out-of-body experiences, such as feeling as though you are watching a movie of yourself
  • Mental health problems such as depression, anxiety and thoughts of suicide
  • A sense of detachment from your emotions, or emotional numbness
  • A lack of a sense of self-identity

The symptoms of dissociative disorders depend on the type of disorder that has been diagnosed. There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):

  • Dissociative Amnesia. The main symptom is difficulty remembering important information about one’s self. Dissociative amnesia may surround a particular event, such as combat or abuse, or more rarely, information about identity and life history. The onset for an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or, rarely, months or years. There is no average for age onset or percentage, and a person may experience multiple episodes throughout her life.
  • Depersonalization disorder. This disorder involves ongoing feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie (depersonalization). Sometimes other people and things may feel like people and things in the world around them are unreal (derealization). A person may experience depersonalization, derealization or both. Symptoms can last just a matter of moments or return at times over the years. The average onset age is 16, although depersonalization episodes can start anywhere from early to mid childhood. Less than 20% of people with this disorder start experiencing episodes after the age of 20.
  • Dissociative identity disorder. Formerly known as multiple personality disorder, this disorder is characterized by alternating between multiple identities. A person may feel like one or more voices are trying to take control in their head. Often these identities may have unique names, characteristics, mannerisms and voices. People with DID will experience gaps in memory of every day events, personal information and trauma. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms. Men are more likely to deny symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states. This can lead to elevated false negative diagnosis.

Causes

Dissociative disorders usually develop as a way of dealing with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Natural disasters and combat can also cause dissociative disorders.

Diagnosis

Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may perform tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality (for example, head injury, brain lesions or tumors, sleep deprivation or intoxication). If physical causes are ruled out, a mental health specialist is often consulted to make an evaluation.

Many features of dissociative disorders can be influenced by a person’s cultural background. In the case of dissociative identity disorder and dissociative amnesia, patients may present with unexplained, non-epileptic seizures, paralyses or sensory loss. In settings where possession is part of cultural beliefs, the fragmented identities of a person who has DID may take the form of spirits, deities, demons or animals. Intercultural contact may also influence the characteristics of other identities. For example, a person in India exposed to Western culture may present with an “alter” who only speaks English. In cultures with highly restrictive social conditions, amnesia is frequently triggered by severe psychological stress such as conflict caused by oppression. Finally, voluntarily induced states of depersonalization can be a part of meditative practices prevalent in many religions and cultures, and should not be diagnosed as a disorder.

Treatment

Dissociative disorders are managed through various therapies including:

  • Psychotherapiessuch as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)
  • Eye movement desensitization and reprocessing (EMDR)
  • Medications such as antidepressants can treat symptoms of related conditions

Related Conditions

Because dissociative disorders appear on the trauma spectrum, many patients may have conditions associated with trauma, as well as additional trauma-based conditions.